Good Practice: Diagnostic Imaging – Authorization and Funding FAQs

Public funding for claims for diagnostic imaging referred by physiotherapists has been in place since 2022. This funding means that Alberta Health pays the costs related to approved forms of diagnostic imaging, when ordered by authorized physiotherapists.

Can all physiotherapists order diagnostic imaging?

No. Authorization to order diagnostic imaging is granted by the College of Physiotherapists of Alberta and is a restricted activity.

For a physiotherapist to become authorized to order diagnostic imaging, they must meet the requirements listed on the Ordering Diagnostic Imaging Requirements page include having a minimum of five years clinical experience in Canada, being registered in Alberta on the General Register, completing the required training, and understanding the Performance of Restricted Activities Standard of Practice.

If you meet the authorization requirements, you can apply for authorization.

You will also need a Practitioner Identification Number (Prac ID) to be able to order diagnostic imaging. The Prac ID enables the radiologist’s reimbursement for reviewing the images and completing the diagnostic imaging report. Prac ID’s are separate from the College of Physiotherapists of Alberta authorization process and can be obtained through Alberta Health by completing the form found here.

Does this mean every client gets a DI referral?

One of the arguments made when physiotherapists initially advocated for gaining authorization to order diagnostic imaging was that a physiotherapist’s knowledge and skill set would allow for appropriate diagnostic imaging referrals specific to musculoskeletal issues.

It is important to recognize that diagnostic imaging is not free. The money to pay for services comes from somewhere, whether it is privately from a person’s own pocket or publicly from taxpayer monies. The Alberta Health Care Insurance Plan (AHCIP) foots the bill for publicly funded diagnostic imaging services which comes from you as an Alberta taxpayer. One issue with diagnostic imaging is the increased cost to our health-care system that comes with unnecessary or low-value tests.  However, financial cost is only one aspect of the cost equation. Low-value tests lead to additional workload, straining the health system and impairing client access to care for other concerns, while offering little or no benefit.1 Physiotherapists must be cognizant of all the issues pertaining to their diagnostic imaging referrals. 

There is also the potential negative cascade of effects on the client from ordering diagnostic imaging such as client anxiety from getting the imaging, incidental findings, over diagnosis, and risks from repeated exposure to radiation.2,3

Physiotherapists are responsible to use diagnostic imaging judiciously keeping in mind necessity of the test, risk to the client, and impact on the health-care system.

What if my colleague has authorization and I ask them to order my client an x-ray?

Consistent with the Performance of Restricted Activities Standard of Practice, the physiotherapist with the authorization to order diagnostic imaging “Orders diagnostic imaging for their own clients only, for the purpose of assisting in the management of their physiotherapy care.”

Physiotherapists should not be referring clients for diagnostic imaging unless they are involved in the client’s care delivery and have assessed the client themselves to determine if the referral is necessary, safe, and will answer the clinical question it is intended for. This is a serious responsibility that should not be treated lightly.

What physiotherapy diagnostic imaging referrals are publicly funded?

Public funding is currently available through the Alberta Health Care Insurance Plan (AHCIP) for diagnostic imaging referrals from physiotherapists for x-ray and ultrasound imaging.

What about MRI?

The College has been advised that the Schedule of Medical Benefits does not include fee codes for Magnetic Resonance Imaging services. This means that public funding for Magnetic Resonance Imaging referred by physiotherapists will not be provided through the Alberta Health Care Insurance Plan.

Authorized physiotherapists can still refer for MRIs if the client is willing to access the MRI through privately funded means.

What is Point of Care Ultrasound (POCUS)?

This is a form of ultrasound examination provided in clinical practice settings with the intent to clarify uncertain findings of the clinical examination or to enhance the quality and effectiveness of interventions. According to the College of Physicians and Surgeons of Alberta, POCUS is an application of ultrasound imaging technology distinct from the more extensive investigation undertaken during a Consultative Diagnostic Ultrasound examination conducted by a radiologist.4

Can I use POCUS in my practice?

No. The Health Professions Restricted Activity Regulation permits physiotherapists to order ultrasound imaging but does not include authorization “to apply ultrasound imaging.” 

Alberta Health has previously confirmed that the application of POCUS is currently not authorized to physiotherapists because of the specific wording of the Health Professions Restricted Activity Regulation. This means that physiotherapists cannot independently apply Point of Care Ultrasound Imaging. Any physiotherapist independently using POCUS in Alberta is, therefore, currently in breach of the legislation.

The College of Physiotherapists of Alberta is aware of practice settings in which physiotherapists are assigned the application of POCUS under the supervision of a duly authorized health professional. For example, some physiotherapists working in hospital-based incontinence clinics perform assessments and treatments using POCUS under the supervision of a physician.

It’s been a while since I regularly referred clients for diagnostic imaging, what do I need to keep in mind?

Regardless of your authorization to refer for diagnostic imaging, physiotherapists are required to practice in a manner consistent with all the Standards of Practice. This includes the Continuing Competence Standard of Practice which states that a physiotherapist must practice “within their level of competence and actively pursues continuous lifelong learning to maintain competence in existing and emerging areas of their practice.” 

As with all areas of practice, if a physiotherapist has not recently used a skill that they are authorized and were previously competent to perform and is uncertain of their currency of knowledge and competence, they are advised to spend some time brushing up on their knowledge and skills before they resume use of the skill in practice.

It is also highly recommended that physiotherapists regularly review the Performance of Restricted Activities Standard of Practice and the performance expectations specific to diagnostic imaging if they are ordering diagnostic images. 

It is important to remember that you are responsible for the imaging you order. That means if a referral is lost along the way and you get a phone call from the client seven weeks later wondering why they haven’t been contacted yet that is on you and your staff to manage and accept responsibility for. That also means that if you haven’t received a diagnostic imaging report back from a provider and an important finding gets lost in the shuffle, you are accountable. Be diligent and construct administrative systems and procedures to track referrals made and the results from those referrals.

Diagnostic imaging can result in urgent findings, and it is up to you to ensure you are aware of the findings and take action as you are the practitioner that ordered the diagnostic imaging. Emergency contact information must be on all imaging orders to enable emergent notification when necessary. If any findings are critical to the client, it is your responsibility to work with the client to ensure they access appropriate care. You must adhere to the requirements of privacy legislation as you carry out these tasks.

Communication and collaboration are imperative

To build on the previous point, communication and collaborative practice are essential. Physiotherapists should be communicating with other members of that health-care team to reduce the occurrence of redundant or duplicative diagnostic images. It is potentially harmful to the client to expose them to more radiation than necessary and is wasteful to the health-care system to duplicate imaging services. Before ordering diagnostic imaging, review the client’s diagnostic imaging history to avoid duplication.

Often a client will book appointments with both you and their physician to discuss results, but this can be a duplication of services if there is no requirement for the client to follow up with the physician. It is important to communicate to the physician the imaging you have referred for, the purpose of the imaging, and that you will follow-up with the client (and physician if needed) once the results are back. Once images you ordered are discussed you have the option to send the client back to the doctor to get a referral for further medical care or treatment if it is required. Proactively explain this plan to the client too.

The authority to order diagnostic imaging comes with taking on the potential risk of harm to your client. Incidental findings on imaging vary depending on the type of imaging and client factors but they are common across all forms of diagnostic imaging.5 Clients who receive an imaging report with incidental findings can find themselves caught in a cascade of care where they are sent for more medical tests, more diagnostic imaging, unnecessary medical procedures and even unnecessary surgical procedures.3,5 All of this comes at the cost to the client and their overall wellbeing without necessarily leading to clinically meaningful outcomes.3

Be intentional when you are ordering diagnostic imaging. What is the specific reason you are ordering it? Will this change the management of this injury? Is the client a surgical candidate? What are the potential unintended consequences of ordering diagnostic imaging for this client? What are the potential incidental findings and what do they mean for the client and the client’s physiotherapy treatment?

These are questions you should be asking yourself when you are trying to decide if you should refer your client for diagnostic imaging or not.

So, what is the key message from this?

If you have the authorization to order diagnostic imaging through the College of Physiotherapists of Alberta and have a Prac ID you can refer clients for specific types of diagnostic imaging, some of which is covered through public funding. You must remember the responsibilities that come with this authorization in relation to client safety, client care needs, and your due diligence to the health-care system as a whole.

Sean FitzGerald, PT, Practice Advisor

Page updated: 12/03/2026